Renal disease in familial dysautonomia

A study of renal disease in familial dysautonomia identified excess glomerulosclerosis in 10 or 13 autopsied and biopsied patients. Sympathetic nerve terminals could not be found on renal vessels in biopsied tissue; they were invariably demonstrable in controls. Altered renovascular responsivity to systemic hypotension in familial dysautonomia may lead to ischemia and subsequent sclerosis of glomeruli. Review of 79 living outpatients showed that clinically overt renal disease was rare in familial dysautonomia. Nevertheless, frequent observations of elevations of serum creatinine concentrations (32% of patients) and blood urea concentrations (76% of patients) indicated a high prevalence of abnormality. An association was found between hypotension and renal dysfunction.

Tyrosine hydroxylase immunoreactivity in familial dysautonomia

Tyrosine hydroxylase antigen was localized immunohistochemically in sympathetic neurons from human autopsy tissue. The reaction persists in paraffin-embedded tissue, and the method is applicable to archival specimens. Increased amounts in this antigen per cell may partially compensate for decreased numbers of sympathetic neurons in familial dysautonomia.

Nucleolar organizing regions of human chromosomes

Silver-stained cells from 49 parents with a history of several abortions were compared with cells from 35 parents with normal liveborn children. The modal and mean number of silver-stained NORs (Ag-NORs) observed on D- or G-group chromosomes was similar in both groups and between males and females. Ag-NORs were randomly distributed on all five acrocentric pairs. The distribution and size of Ag-NORs within an individual was not random and was fairly consistent from cell to cell. The mean number of associations per cell was similar in both males and females of the abortion group and was less than the number of associations in controls. The probability of D- or G-group chromosomes being associated was near the expected probability of 0.6 for D-association and 0.4 for G-association. The frequency of association of any chromosome combination did not differ statistically from the expected values, though the number of associations, 15/22, was higher than expected.

Proteoglycan aggregates in adult human costal cartilage

1. A sequential extraction procedure using isotonic KCl and 4.0 M guanidine hydrochloride was used to solubilise proteoglycans from adult human costal cartilage under conditions minimising autolysis. Up to 28% of the total tissue hexuronate was extracted. 2. Proteoglycan fractions were prepared from the extracts by CsCl equilibrium density gradient centrifugation. 3. Each fraction exhibited distinct electrophoretic heterogeneity. 4. Proteoglycans extracted by isotonic solutions are relatively small and may be in vivo degradation products of whole molecules. The major fraction (A1) from high ionic strength extracts has a composition similar to that of A1 proteoglycans from adult human articular cartilage. A2 fractions differ and are highly enriched in protein. 5. A1 and A2 fractions from high ionic strength extracts contain proteoglycan aggregates, but to a much lesser extent than found in other cartilages like bovine nasal or porcine epiglottal cartilage. 6. The aggregates can be dissociated and a 'subunit" proteoglycan isolated by CsCl density gradient centrifugation in 4.0 M guanidine hydrochloride. 'Subunits' can reaggregate partially, when mixed with fractions of lower density from the gradient. 7. Addition of hyaluronic acid to A1GuHCl promotes a large increase in the amount of aggregate present. 8. The hyaluronic acid content of costal cartilage is not deficient compared to that of other hyaline cartilages. 9. Polypeptides with molecular weights suggesting their identity as 'link proteins' are present in A1 and A2 fractions. 10. Additional polypeptides of higher molecular weight than link proteins are also present in A1 and A2 fractions. They may represent the hyaluronic acid binding region of proteoglycans and compete with 'whole' proteoglycans for hyaluronate in the tissue.

Simple apparatus for measuring the dynamic shear modulus of cylindrical specimens

An apparatus is decribed which has been used to determine the shear modulus of cylindrical specimens vibrating in the torsional mode. The specimens are maintained in self-excited vibration by an eddy-current driver, an eddy-current pickup, and a feed back circuit consisting of a phase-locked-loop and an amplitude control module. The system has a frequency stability of 1 part in 10(6) for high-Q materials (a few thousand) in the audio range. In addition, it can automatically track frequency changes of a few percent with negligible error in phase or frequency.

Fatal cerebral injury in the elderly

A medical examiner's series of 71 elderly patients with fatal internal cerebral injuries demonstrated age differences with respect to the type of cerebral lesion and the causal incident. The elderly showed relatively fewer severe cerebral contusions than did a young group, but a higher incidence of subdural and intraparenchymal hematomas. Falls, the most common cause of injury in the elderly, were often precipitated by physical illness or ingestion of alcohol. Consumption of alcohol was also a prominent factor in the fatal assault cases.

Quantitative studies of sympathetic ganglia and spinal cord intermedio-lateral gray columns in familial dysautonomia

In adult patients with familial dysautonomia the mean volume of superior cervical sympathetic ganglia is reduced to 34% of the normal of 222 mm3. Packing density of neurons is reduced to 37% of normal. The mean total number of ganglionic neurons is 120,000 as compared to 1,060,000 in controls. The mean totals of preganglionic neurons in the first three thoracic cord segments are 13,600 in patients and 25,150 in controls. Deficits in sympathetic neurons account for many of the clinical, pharmacological and biochemical manifestations of familial dysautonomia.

Quantitative studies of ciliary and sphenopalatine ganglia in familial dysautonomia

In 3 patients with familial dysautonomia (FD) sphenopalatine ganglia were less than one fifth normal in volume and their total neuronal content was reduced to a mean of 1,510 (control mean 56,500). Parasympathetic denervation accounts for absence of overflow tears in FD. Ciliary ganglia were not reduced in volume and in 4 patients the mean neuron total was only slightly diminished to 2,900 (control 3,670, P less than or equal to 0.05). This does not appear sufficient to account for pupillary supersensitivity to methacholine in FD on the basis of denervation. Temporal differences in the embryogenesis of sphenopalatine and ciliary ganglia may underlie the observed differences in neuronal populations and suggest that the developmental anomaly in FD does not occur early in gestation.

Epidural lipoma simulating lumbar disc protrusion

Spinal lipomata are usually associated with congenital anomalies. A lipoma, presenting with symptoms, signs and myelographic findings suggestive of a lumbar disc protrusion, is rare. Asymmetry of the origin of some of the scaral nerve roots may be the clue for suspecting epidural lipoma pre-operatively.

Rearrangements involving four chromosomes in a child with congenital abnormalities

This report describes a complex structural rearrangement between chromosomes X and 1 and a 7;13 translocation (together involving six break points) in a child with multiple congenital defects. Both parents showed a normal chromosome complement, suggesting that the changes may have originated either in a gametic nucleus or at a very early stage of zygotic development.

Quantitative studies of dorsal root ganglia and neuropathologic observations on spinal cords in familial dysautonomia

Intrauterine development and postnatal maintenance of dorsal root ganglion neurons are abnormal in familial dysautonomia, an autosomal recessive disorder associated with autonomic, motor and sensory deficits. Normally, dorsal root ganglion weight increases with age. This does not occur in the cervical plexus ganglia of dysautonomic patients. Neurons in dorsal root ganglia are found to be markedly diminished in the youngest patients and slow degeneration causes further depletion with age. Quantitative studies on C8 dorsal root ganglia show the normal neuron content to be between 42,500 and 53,600. In 3 patients with familial dysautonomia the range was 4,090-8,590 with the smallest number being in the oldest patient. Lateral root entry zones and Lissauer's tracts are severely depleted of axons. In older patients loss of dorsal column myelinated axons becomes evident and is first seen in lumbar fasciculus gracilis, cervical fasciculus cuneatus and interfascicular fasciculus. Temperature sensation is markedly impaired from infancy in familial dysautonomia. Loss of pain sensation is prominent and worsens with age. Vibration sense diminishes in adolescence and coordination of limb movements becomes poor in older patients. Neuron depletion in dorsal root ganglia and the progressive pattern of cord changes correlate well with these clinical observations.

Brain death: I. Angiographic correlation with the radioisotopic bolus technique for evaluation of critical deficit of cerebral blood flow

An innocuous intravenous portable radioisotopic test using technetium 99m pertechnetate was employed to demonstrate the deficit of cerebral blood flow associated with brain death. The results are compared to those of bilateral carotid and vertebral angiography in 20 patients. Absence of a bolus tracing from the head in the presence of a control tracing of a bolus from the femoral artery in two successive studies one hour apart reliably correlated with the clinical and electroencephalographic findings signifying cerebral death in comatose, apneic patients. Angiography indicated absence of intracranial circulation in 10 patients. Stasis filling or retrograde emptying of arterial vessels (or both) occurred in 7 patients. There was no evidence of venous filling in any of these 17 patients; all of them had either an absent head bolus or an "intermediate tracing." Results indicate that either form of tracing represents a critical decrease of cerebral blood flow. Two other patients had evidence of severely impaired abnormal posterior fossa circulation without angiographic evidence of cerebral circulation; both of these patients had an absent head bolus. An additional patient had an unusually small head bolus, and angiography revealed extravasation of radiopaque material but no evidence of intracranial circulation. We conclude that the bolus technique is a helpful adjunct in diagnosing brain death.

Brain death: II. Neuropathological correlation with the radioisotopic bolus technique for evaluation of critical deficit of cerebral blood flow

Diffuse necrosis and autolysis were found in the brains from 6 comatose, respirator-supported patients in whom the bolus technique demonstrated no cerebral blood flow during a period exceeding 20 hours prior to cardiac death. When blood flow was insufficient to produce a bolus, there was no evidence of active tissue response to necrosis. In 6 similar patients, when cerebral blood flow was detected by the bolus technique, less extensive necrosis was observed postmortem and there was active tissue response.

Effects of depot injections of retinyl palmitate on 7,12-dimethylbenz[a]anthracene-induced preneoplastic changes in rat skin

The preneoplastic skin changes usually induced by topical application of 7,12-dimethylbenz[a]anthracene (DMBA) to adult rat skin did not appear when animals were treated locally with depot im injections of high doses of retinyl palmitate (RP) prior to exposure to the carcinogen. The epidermal histology after RP-DMBA treatment was similar to that seen in areas exposed to RP alone. Keratinization was inhibited but there was no cellular atypia, evidence of cell injury, or mucous metaplasia. Other features were hyperplasia with acanthosis and thickened stratum granulosum, parakeratosis, intercellular edema, and loss of hair overlying the injection site. Ultrastructurally, the epidermal cells contained conspicuously fewer tonofibrils and increased dense chromatin, when compared to control cells. Skin changes observed following treatment of littermates with DMBA alone included the appearance of giant tumor cells, dyskeratotic cells, nuclear hyperchromatism, increased nucleocytoplasmic ratio, and pleomorphic nuclei and nucleoli. oss of desmosomes, increased tonofibrils, and defects in the basement membrane with epithelial projections into the dermis were also seen. These preneoplastic changes did not regress when application with DMBA was discontinued after 6 weeks; exposure to the carcinogen for longer than 6 weeks resulted in an exacerbation of the abnormal state. RP had profound effects on rat epidermis that interfered with the effects of a potent skin carcinogen. The mechanisms underlying the phenomenon have not been defined. The use of depot injections of the vitamin which avoids both systemic toxicity and the local irritation seen with topical exposure could serve as a model in which the anticarcinogenesis properties of retinoids could be explored.